2 questions answered

Barry Washington wants to know what plans under these exchanges will cover? When he gets sick, will they cover everything 100 percent or are they going to be at the mercy of these for-profit health insurance companies?

“Probably the first question to ask when you’re starting to consider these plans, and there’s a couple of points to be made here. He mentions the profit of the insurance companies; one of the things the Affordable Care Act does is limits the profit, so if they don’t spend a certain amount of their premiums on health care, they have to refund the money. It should said that all these plans cover preventive care, annual checkups, vaccinations, things like that with no out-of-pocket costs, so go to your doctor, get the preventive stuff, it’s not going to cost you anything. However, you should check the deductibles and copay’s of each of these plans. As Barry points out, some of the premiums are low, they do come, some of them, with multi-thousand dollar deductibles. On the other hand, there is an out-of-pocket limit under the Affordable Care Act. Individuals cannot, will not pay more than $6,350 out of their pocket. So even with a haughty deductible, there is some ceiling on what you’re going to pay out.”

Cathy, whose husband was recently fired, which caused them to lose their private employer insurance, has children who are now covered by state insurance and wants to know what happens if they apply for the exchanges and then her husband gets a job and gets coverage?

“One of the things that happens in the exchange is you get subsidized based on your income, and so, right now, if there is unemployment insurance income going on, that is counted as part of your income. If he gets a job and the income goes up, that affects the subsidies—that all factors into the exchange software. When you’re on there, if it works the way it’s supposed to, and there are some doubts about that, it may take a while. When you go on there, all of that gets plugged in, and you can even factor in what if situations and see how the prices might change, how it affects you in some different scenarios, what you think might happen to your income.”

To hear more of Jay Hancock’s answers, listen to the audio at the top of this page.

Guest

Key parts of the Affordable Care Act go into effect tomorrow with health insurance exchanges open for enrollment. Judging by our website, hereandnow.org, Americans have a lot of questions.

Last week, we had our occasional Obamacare 101 segment, your chance to get your questions about these marketplaces answered. Today, Jay Hancock of Kaiser Health News is back to answer more. Jay, welcome back.

JAY HANCOCK: Hi. Nice to be here.

YOUNG: And again, to remind ourselves, starting tomorrow, people, for instance, who aren't on Medicare, who are - or don't get their insurance through an employer can go online or, as you reminded us, can go talk to an insurance broker. They can help you to look through different plans, see which one is best for them. Let's get to some of the questions people are asking.

Barry Washington asks - he says, I'd like to know which plans under these exchanges will cover - or what they will cover. What plans under these exchanges will cover? He says, the prices sound great. But specifically, what are they going to cover if I get sick? Will they cover everything 100 percent, or are we going to be at the mercy of these for-profit health insurance companies?

HANCOCK: Terrific question, probably the first question to ask when you're starting to consider these plans. And there's a couple of points to be made here. He mentions the profit of the insurance companies. One of the things the Affordable Care Act does is limits the profit. So if they don't spend a certain amount of their premiums on health care, they have to refund the money. It should be said that these - all these plans cover preventive care, annual checkups, vaccinations, things like that, with no out-of-pocket costs. So, you know, go to your doctor, get the preventive stuff. It's not going to cost you anything.

However, you should check the deductibles and the co-pays of each of these plans. As Barry points out, some of the premiums are low. They do, however, come, some of them, with multi-thousand-dollar deductibles. On the other hand, there is an out-of-pocket limit under the Affordable Care Act. Individuals cannot - will not pay more than $6,350 out of their pocket. So even with a high deductible, there is some ceiling on what you're going to pay out.

YOUNG: OK. You check to see how much you have to pay before you get covered, but there should be a cap on that, and you should get covered, in general.

HANCOCK: Correct.

YOUNG: Yeah.

HANCOCK: Correct.

YOUNG: Cathy(ph) asks: My husband was recently fired - sorry about that - and she said, we've lost our private employer insurance. Our children, though, are now covered by state insurance. The parents didn't qualify. So what happens if we apply - and then her husband does get a job that has health insurance benefits? Also, what if we lose unemployment benefits when we do start needing to pay for any of these? So start with the - what happens if they apply for the exchanges and then he gets a job and gets coverage?

HANCOCK: One of the things that happens in the exchange is you get subsidized based on your income. And so, right now, if there's unemployment insurance income going on, that is counted as part of your income. If he gets a job and the income goes up, that affects the subsidies. That all factors into the exchange software. When you're on there, if it works the way it's supposed to - and there are some doubts about that. It may take a while. When you go on there, all that gets factored in. And you can even plug in what-if situations and see what - how the prices might change, how it affects you in some different scenarios of what you think might happen to your income. So it's worth...

YOUNG: Oh, fascinating.

HANCOCK: ...worth going on there and checking that out.

YOUNG: Well - and you also - at Kaiser Health News - we've said this before - but you have a health care subsidy calculator at your website, will link people up. And there also, you can put all the information and then see if you qualify for some government subsidy for health care. You may be making too much for Medicaid coverage but not enough to cover any of the plans in the exchanges, and you might be eligible for a subsidy. So there's that as well.

Encinita Express(ph) writes: We have two boys in college. They are 23 and 21. We live in California, but our sons attend college in New York and Washington state respectively and are only home three weeks a year. So they're essentially out-of-state residents, and that, she says, makes finding a health plan for the four of us nearly impossible.

So how do they go about this? Do we need to purchase a plan for the parents in California and policies for the kids where they go to school? What's the answer, Jay?

HANCOCK: A couple of different things they can look at. Some multi-state insurance companies, like the Blue Cross plans, Kaiser Permanente, do offer plans in multiple states, where you can buy the plan where beneficiaries at one place and the parents are in another place, and that might work. There are also - and this includes California - some states that will be offering multi-state plans in the exchange, in these online marketplaces that we keep talking about, where you get the subsidies. And those states will also allow coverage across different states. One other thing to look at is - she mentioned separate policies. That may, indeed, also be an option under the California marketplace. There is - under IRS rules, there is nothing that precludes parents from buying dependents separate polices on these exchanges. They're completely allowed to do that. That is a possibility. Again, they need to work out through different scenarios to see what it might mean on their initial cost and their out-of-pocket cost.

YOUNG: OK. And what about a student who's parent can't buy them insurance? This - Kelly writes she's 22 years old, a college student. Her mom is on Medicaid, but she was kicked off - Kelly was - when she started school. She says, I'll graduate this spring. I'll be getting married right after. Should she look into the health care exchange or hope that she'll be covered by her soon-to-be husband's insurance when he gets a job?

HANCOCK: Right. Again, there are some what ifs in her situation. It sounds like Kelly is going to exceed that three-month coverage gap that is allowed under the Obamacare penalty. As we've stated in the past, you are obligated to get coverage. You have to pay a penalty if you don't have coverage. But they do allow short-term coverage gaps of three months. If her husband finishes school in May and she gets married in June, it sounds like that'll be more than three months.

She could - she should go back and, again, look at what's going on her state. If there is a state Medicaid expansion - and not all states are expanding their Medicaid program - but if there is, she may qualify under that as a student or she may qualify under the individual commercial policies that you can buy through the online exchange that we're talking about.

YOUNG: And, Jay Hancock, one last quick question. Kyrios(ph) writes: What if I'm not eligible for Obamacare because of the requirements? You have to be a citizen or a legal immigrant. Will I still have to pay a fine? Doesn't seem fair, says Kyrios.

HANCOCK: Yeah. No. If you're not eligible for Obamacare, if you're not required to get Obamacare - and people that fit into those groups include folks on Medicare, as you mentioned - if you're covered by the Veterans' Administration, if you can't afford it, if there's a hardship, if you have religious views that keep you from getting this kind of health insurance, you are not obligated to get it and you don't have to pay the penalty if you don't.

YOUNG: Boy. I hope that helps with those questions. There are so many others. We're going to keep doing this, Jay Hancock of Kaiser Health News, because no one expect it's going to go perfectly tomorrow, and there are still questions outstanding. So will you come back?

HANCOCK: Absolutely.

YOUNG: Thanks so much. And keep sending your questions to hereandnow.org. Some listeners are weighing in with answers as well. Back in a minute. HERE AND NOW. Transcript provided by NPR, Copyright NPR.